Nut Allergies: How to Nutproof Your Life

BE A SMARTER PERSON WITH A NUT ALLERGY

WHAT ARE TREE NUT AND PEANUT ALLERGIES?

Almost any food may cause a food allergy. But researchers and scientists have identified eight main foods as causing 90% of all food allergies on an international scale. These are the following: cow’s milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish.

A tree nut allergy is an allergic reaction to the proteins found in tree nuts. On the same note, a peanut allergy is an allergic reaction to the proteins found in peanuts. Some of us already know that a peanut isn’t actually a true nut. It’s a legume. Unfortunately, the structure of the proteins found in peanuts are pretty similar to the structure of the proteins in any of the tree nuts. This is the reason why people who are allergic to tree nuts can also be allergic to peanuts. It’s estimated that up to 30% of people allergic to one tree nut will also be allergic to peanuts. If you’re allergic to one type of tree nut, the probability that you’re allergic to other types of tree nuts can be as high as 30%.

The most common tree nut allergies of medical concern in both adults and children are almond, walnut, Brazil nut, pecan, hazelnut, macadamia nut, pistachio, and cashew nut. Other nuts not on this list may still cause a food allergy. Some people outgrow their food allergies over time (like egg, soy, and milk allergies). Sadly, most people with tree nut and peanut allergies don’t outgrow theirs and they usually last a lifetime.

SOME QUICK STATISTICS ON TREE NUT AND PEANUT ALLERGIES

New Zealand and Australia have among the highest rates of allergic diseases in the developed world.

In Australia, it’s estimated that almost 20% of the population have at least one allergic disorder. Approximately 1 to 2% of adults and 4 to 8% of children under five years old have a food allergy. The most common food allergy was a peanut allergy, followed by prawns, milk, and egg. The overall incidence of food allergies among infants is 10%, of which 3% is attributed to a peanut allergy. In New Zealand, food allergies also affects up to 10% of infants. The usual culprits are milk, peanuts, and eggs. The overall incidence of food allergies among the general population can be as high as 5%. Tree nuts and peanuts combined account for 70 to 90% of documented anaphylaxis fatalities secondary to food on a global scale. Tree nuts alone accounts for approximately 18 to 40%.

WHAT HAPPENS IN YOUR BODY DURING AN ALLERGY TO A TREE NUT OR PEANUT?

If you have a nut allergy, your immune system overreacts to the proteins in the nut. As a result, your body thinks that these proteins are potentially harmful substances and react by attacking them. The result is an allergic reaction. The severity of the allergic reaction depends on the scale of your immune system’s response to the harmful substance. The type of allergic reaction is classified as type I hypersensitivity reaction (there are four main types). A severe type I hypersensitivity reaction is termedanaphylaxis (see below).

WHAT ARE THE CLUES (SIGNS AND SYMPTOMS) OF A NUT ALLERGY?

If you have a tree nut or peanut allergy and accidentally eat something with nuts, your body releases histmine, a local hormone. This substance is mainly responsible for the signs and symptoms of an allergic reaction to nuts. It can cause the following:

Clues of a Nut Allergy

Hives (also called urticaria) are itchy, red welts.	Diarrhoea
Swollen, itchy, or watery eyes	Abdominal pain
Problem breathing properly	Hypotension or a drop in blood pressure
Wheezing	Fainting or dizziness
Coughing	Anxiety
Sneezing	Hoarse voice
A feeling of a lump or tightness in the throat	Vomiting
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Note: Allergic reactions to tree nuts and peanuts will differ between people allergic to them. One person’s response can vary significantly during different allergic episodes.

Diagnosis of A Nut Allergy

A general practitioner (GP) can diagnose an allergy to peanuts or tree nuts based on your medical history and signs and symptoms. Your GP may also refer you to a board-certifiedallergologist (also called anallergist). An allergologist is a physician specifically trained to prevent, diagnose, and treat allergic diseases. In addition, they would want to know your family history and any other co-morbid medical conditions you have. A part of your responsibility for identifying a nut allergy is starting and maintaining afood diary. This is particularly helpful because it will contain the list of foods you’re eating and state what signs and symptoms may follow.

Tests used to aid in the diagnosis of nut allergies includeskin prick tests andblood tests. A skin prick test involves gently introducing small amounts of tree nut proteins to your skin to determine if there’s a reaction. RAST, orradioallergosorbent testing, is a blood test utilised to detect antibodies called immunoglobulin E (IgE for short). So, for example, if you have a specific food allergy, there will be immunoglobulin E antibodies against that particular food in your blood. A more sophisticated version of RAST exists and is calledCAP-RAST. It determines the presence of immunoglobulin E antibodiesand also measures the amount. This is recognised as the gold standard for immunoglobulin E blood testing.

You may also be requested to try an exclusion orelimination diet. It’s an intelligent way to confirm the results of your allergy testing. Another practical test involved in the diagnosis is anoral food challenge. The results of all of these tests will be combined with your history and physical examination to formulate a diagnosis of a nut allergy.

Some at-home testing kits for food allergies are being sold online and in stores. Please remember that there have been concerns regarding the accuracy of their results. This may lead you to miss out on certain healthy foods. Ask your healthcare practitioner first before using them.

TREATMENT OF NUT ALLERGIES

Peanut and tree nut allergies can lead to a severe allergic reaction called anaphylaxis.Anaphylaxis may start with a few of the same signs and symptoms mentioned above but will swiftly get worse and give you difficulty breathing or you may even pass out. Anaphylaxis can be fatal if not treated promptly.

Those with a tree nut or peanut allergy are required to carry an epinephrine auto-injector (also known as an EpiPen) in case of an emergency. It’s a medicine prescribed to you by your doctor. It’s simple to use and easy to take with you wherever you go. Your doctor should demonstrate to you how to use it. BRING IT WITH YOU AT ALL TIMES. If you can bring your cell phone everywhere (Including the loo!), you can do the same with your EpiPen. Inform a trusted friend who’s with you where you keep your epinephrine.

If you have severe allergic signs and symptoms like difficulty breathing, swelling of the throat and mouth, vomiting, and hives, use your EpiPen immediately. Every second counts in this type of severe allergic reaction (anaphylaxis). You will receive special instructions from your doctor on what to do if this happens. In addition, your close friends, people you work with, and others around you should be aware of your situation. In addition, it would be best to wear a medical alert bracelet or jewellery. It will contain all your unique medical information.

The treatment for milder forms of allergic reactions (compared to anaphylaxis) includes oral antihistamines (over the counter) and corticosteroids. Intramuscular and intravenous forms of these medicines are also available and should be prescribed and given by a healthcare professional. The best treatment for tree nut or peanut allergies will always be prevention, which means staying away from specific nuts entirely.

NUTPROOF YOUR LIFE: HOW TO LIVE WITH A TREE NUT OR PEANUT ALLERGY

The number one on our list is obvious. To Prevent an allergic reaction, don’t eat any tree nuts, peanuts, tree nut products, or peanut products. If you’re allergic to one, it’s best to avoid all nuts.

Always read the ingredients label on the foods you buy and eat. Avoid the foods that include tree nuts, peanuts or any of the following ingredients:

Almond	Praline	Beechnut
Pistachio	Brazil nut	Butternut
Cashew	Chestnut	Chinquapin or chinkapin nut
Shea nut	Hazelnut/Filbert	Pili nut
Ginkgo nut	Hickory nut	Lychee nut
Macadamia nut	Almond paste marzipan	Nangai nut
Natural nut extracts*	Nut butters (e.g., almond butter, peanut butter)	Nut alcoholic extracts
Pine or Indian nut	Walnuts	Nutella
Nut oils	Nut paste	Pecan
Pesto	Nut meats (e.g., chopped pecans in a pecan pie)	Nut milk (non-dairy milk alternative, made from nuts soaked in water and blended into a creamy beverage)
Black walnut hull extract (for flavouring and medicinal purposes)	Artificial nuts (peanuts made to taste like tree nuts)	Gianduja or gianduia (a mixture of chocolate and nut)
Nut meal (nuts ground to a coarse flour)	Peanuts
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*Artificial nut extracts are generally safe for people with a nut allergy. An example would be imitation almond extract which isn’t made from real almonds. Always check if the extract came from real nuts, which means that the person with a nut allergy should avoid this.

Note: The list above doesn’t include all foods and ingredients. If you see something you don’t know on the label, do your research first before buying it.

To set the record straight, a coconut is not a giant nut. Botanically speaking, it’s a drupe (fruit with a hard covering enclosing the seed). There’s a small number of people who are allergic to coconut. Most of these people don’t have a co-existing tree nut or peanut allergy.

Below is another table of well-known foods almost all of us are familiar with. These foods may contain tree nuts or peanuts as ingredients. We know most of these taste really good.

Biscuits	Macaroons
Crackers	Trail mix
Baked goods	Flavoured coffee
Museli bars	Cereal
Lollies or candy	Caponata (pine nut dish)
Ice cream	Barbecue sauces
Marinades	Frozen desserts
Energy bars	Mortadella (Italian sausage or luncheon may contain pistachios)
Alcoholic beverages that may contain nut flavouring	Salads and salad dressings
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You’re never too old. Most food allergies begin in childhood, but adults can develop food allergies too. It’s still puzzling to researchers as to why some adults acquire an allergy to a food they have previously consumed without an allergic reaction. Remember, it can happen.

Not all sources of nut are edible. Tree nut oils, like almond and walnut, are sometimes used in lotions, soaps, and hair care products. Hey, if they can justify using sheep or human placenta on your skin, they can undoubtedly justify using tree nuts for similar products. Some natural brushes or sponges contain crushed walnut shells because of their durability. Thesemay trigger an allergic reaction and leave you clueless as to where your exposure is coming from. Your hypersensitivity to these products may differ from other people with the same allergy.

Let’s eat out. Eating out at restaurants may be challenging, but don’t limit yourself to simply checking out the menu. Ask the server, manager, or even better, the chef about the ingredients of the food you plan on ordering and eating. Be sure to inform the management that you have a tree nut or peanut allergy because your food may be prepared on the same surface or cutting board where the foods containing nuts were prepared ( cross-contact).Are you familiar with a chef card? Food allergy websites have downloadable forms available in several languages. These forms detail your allergy and help the restaurant staff prepare your food safely. Also, some cuisines from around the world are fond of adding nuts:

Indian (cashew, almonds, and peanuts)
Italian (pine nuts)
Chinese, Vietnamese, and Thai (cashews)
Greek (walnuts)
Mediterranean (almonds, hazelnuts)

If you’re attending a friend’s party, make sure that you inform them about your allergy. They can make some simple preparations in advance. In addition, don’t use other people’s utensils or drink from their cup. A trace of peanut butter on a cup or spoon that may be invisible to the naked eye can cause an allergic reaction in some people.
Are you planning to travel soon? Whether you plan to travel locally or abroad, the best strategy to manage your allergy is to plan your entire trip. Know where the nearest hospitals are and note how long it will take you to get there. Bring enough medicine with you, and don’t forget to handle them with care. Also, keep your emergency action plan with your medications. You should have formulated this with your doctor before your trip. Finally, don’t forget to inform the people you’re travelling with that you have a nut allergy.
The safest food to eat is the food that you prepared. When in doubt about whether a food or ingredient is safe or not, always ask your allergist.

Tree nuts and peanuts are among the most common foods that cause allergies. There’s puzzling evidence that food allergies worldwide have increased significantly in the past decade, particularly to peanuts. The exact reasons for this remain unknown. The best that you can do for now is to stay vigilant, keep updated, and be aware of the foods you’re eating. Don’t forget to have regular check-ups with your GP and allergist. We have another article on allergies you may want to take a look at, click here.